Tesis

Korelasi Antara Nilai Rasio LDL-C/HDL-C dan Nilai Rasio Neutrofil/ imfosit dengan Beratnya Stenosis pada Pasien IMAEST = The Correlation Between The LDL-C/HDL-C Ratio and The Neutrophil/Lymphocyte Ratio with The Severity of Stenosis in STEMI Patients.

Latar Belakang Penyakit jantung koroner (PJK) merupakan penyebab kematian utama di seluruh dunia. Manifestasi PJK ditentukan oleh berat dan kompleksitas stenosis dari plak aterosklerosis. Indeks aterogenik LDL-C/HDL-C dan indeks inflamasi Nilai Rasio Neutrofil/ imfosit (NLR) yang menggambarkan beban kolesterol dan beban inflamasi, merupakan pemain kunci dalam pembentukan plak aterosklerosis. Kedua indeks ini memiliki korelasi positif dengan derajat berat stenosis plak aterosklerosis (skor Gensini). Korelasi positif yang bermakna antara LDL-C/HDL-C dan NLR dengan skor Gensini juga dijumpai pada sindroma koroner akut. Namun di sisi lain, studi menunjukkan beban inflamasi yang tinggi dapat mempengaruhi metabolisme lipoprotein kolesterol. IMA-EST merupakan sindrom koroner akut dengan beban inflamasi yang paling tinggi. Tujuan Untuk mengetahui korelasi antara indeks aterogenik LDL-C/HDL-C dan indeks inflamasi NLR dengan beratnya stenosis, dan korelasi kedua faktor risiko tersebut pada pasien sindroma koroner akut IMA-EST . Metode Penelitian ini dilakukan dengan desain potong lintang. Sebanyak 99 pasien terpilih dari pasien IMA-EST yang menjalani IKP primer di laboratorium kateterisasi jantung RSUP Dr. Cipto Mangunkusumo memenuhi kriteria inklusi dan eksklusi dari tahun 2018-2023. Dari data rekam medis pasien didapatkan profil klinis pasien dan data angiografi koroner. Dari data angiografi koroner dilakukan penghitungan skor gensini kemudian dibagi atas 3 tertil yang menggambarkan ringan, sedang dan berat stenosis (tertil I: ≤ 27, tertil II: 28 – 60, tertil III: ≥ 61. Data dianalisis menggunakan Statistical Product and Service Solutions (SPSS) for Windows versi 25.0. Analisa korelasi menggunakan uji Spearman Hasil Hasil penelitian menunjukkan tidak ada korelasi yang bermakna antara rasio LDLC/HDL-C dan NLR dengan skor Gensini (r = -0.051, p = 0.617; r= -0.126, p = 0.241). Korelasi yang tidak bermakna juga dijumpai antara rasio LDL-C/HDL-C dengan skor Gensini di semua tertil (Tertil I: r = 0.001, p = 0.997; Tertil II: r = 0.145, p = 0.429; Tertil III: r= -0.088, p = 0.620), dan NLR dengan skor Gensini di semua tertil ( Tertil I : r = - 0.036, p = 0.843 ; Tertil II: r = -0.108, p = 0.555; Tertil III: r = -0.065, p = 0.713). Namun dijumpai korelasi negatif yang bermakna antara rasio LDL-C/HDL-C dengan NLR (r = - 0.262, p = 0.009). Korelasi negatif antara rasio LDL-C/HDL-C dengan NLR ini tetap dijumpai pada tiap tertil, meskipun yang bermakna secara statistik pada studi ini dijumpai pada tertil I yang memiliki indeks inflamasi yang paling tinggi (Tertil I: r = -0.445, p = 0.009, Tertil II: r = -0.035, p = 0.851, Tertil III: r = -0.290, p = 0.097). Kesimpulan Tidak dijumpai korelasi bermakna antara indeks aterogenik LDL-C/HDL-C dengan skor Gensini dan indeks inflamasi NLR dengan skor Gensini pada IMA-EST. Namun pada IMA-EST dijumpai korelasi negatif yang bermakna antara indeks aterogenik LDLC/HDL-C dengan indeks inflamasi NLR.
Kata Kunci Skor Gensini, LDL-C/HDL-C, NLR, IMA-EST


Background Coronary heart disease due to atherosclerotic disease (CHD) is the leading cause of death worldwide. The manifestation of CHD is determined by the severity and complexity of stenosis caused by atherosclerotic plaques. The atherogenic index of LDL-C/HDL-C and the inflammatory index Neutrophil/Lymphocyte Ratio (NLR), which describe the cholesterol burden and inflammatory burden respectively, are key players in the formation of atherosclerotic plaques. Studies show that these two indices have a positive correlation with the severity of atherosclerotic plaque stenosis (Gensini score). A significant correlation between LDL-C/HDL-C and NLR with the Gensini score is also found in acute coronary syndrome. However, on the other hand, studies show that in high inflammatory burden there is a change in cholesterol lipoprotein metabolism. STEMI is an acute coronary syndrome with the highest inflammatory burden. Objective To determine the correlation between the atherogenic index LDL-C/HDL-C and the inflammatory index NLR with the severity of stenosis, and the correlation of these two risk factors in patients with STEMI. Method This study was conducted using a cross-sectional design. A total of 99 patients were selected from STEMI patients who underwent primary PCI at the cardiac catheterization laboratory of Dr. Cipto Mangunkusumo, Indonesia National Central General Hospital, based on inclusion and exclusion criteria from 2018 to 2023. Clinical profiles and coronary angiography data of patients were obtained from medical records. Gensini score calculation was performed based on coronary angiography data, which was then divided into 3 tertiles representing mild, moderate, and severe stenosis (tertile I: ≤ 27, tertile II: 28 – 60, tertile III: ≥ 61). Data were analyzed using Statistical Product and Service Solutions (SPSS) for Windows version 25.0. Correlation analysis was conducted using the Spearman test. Result The results of the study showed no correlation between the LDL-C/HDL-C ratio and NLR with the Gensini score (r = -0.051, p = 0.617; r = -0.126, p = 0.241). No correlations were also found between the LDL-C/HDL-C ratio and the Gensini score in all tertiles (Tertile I: r = 0.001, p = 0.997; Tertile II: r = 0.145, p = 0.429; Tertile III: r = -0.088, p = 0.620), and between NLR and the Gensini score in all tertiles (Tertile I: r = -0.036, p = 0.843; Tertile II: r = -0.108, p = 0.555; Tertile III: r = -0.065, p = 0.713). However, a significant and inverse correlation was found between the LDL-C/HDL-C ratio and NLR (r = -0.262, p = 0.009). This inverse correlation between the LDL-C/HDL-C ratio and NLR was consistently found in each tertile, although statistically significant in this study was found in tertile I, which had the highest inflammation index (Tertile I: r = -0.445, p = 0.009, Tertile II: r = -0.035, p = 0.851, Tertile III: r = -0.290, p = 0.097). Conclusion No significant correlation was found between the atherogenic index LDL-C/HDL-C and the Gensini score, nor between the inflammatory index NLR and the Gensini score in STEMI. However, in STEMI, a significant negative correlation was found between the atherogenic index LDL-C/HDL-C and the inflammatory index NLR.
Keywords Gensini score, LDL-C/HDL-C, NLR, STEMI